Improving EPSDT screening for Amerigroup Iowa, Inc. members. Education for PCPs
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1 Improving EPSDT screening for Amerigroup Iowa, Inc. members Education for PCPs WEBPIA December 2015
2 What is EPSDT? Early and periodic screening, diagnosis and treatment (EPSDT) is Medicaid s comprehensive and preventative child health program for individuals under the age of 21. Early - Identifying problems early, starting at birth Periodic - Checking children s health at periodic, age-appropriate intervals Screening - Doing physical, mental, developmental, dental, hearing, vision and other screening tests to detect potential problems Diagnosis - Performing diagnostic tests to follow up when a risk is identified Treatment - Treating the problems found 2
3 What is EPSDT? (continued) Defined by law as part of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) legislation Requires states to cover all services within the scope of the federal Medicaid program Includes periodic screening, vision, dental and hearing services among its requirements Requires (per Section 1905(r)(5) of the Social Security Act) that any medically necessary health care service listed in Section 1905(a) be provided to an EPSDT recipient, even if the service is not available under the state's Medicaid plan to the rest of the Medicaid population In Iowa, EPSDT is called Care for Kids 3
4 Our state partners programs New Jersey NJ Family Care Tennessee TennCare Kids New York Child Health Plus (CHPlus) Florida Florida Healthy Kids (FHK) (CHIP) Wisconsin Health Check Louisiana LaCHIP Maryland Healthy Kids Texas CHIP Virginia EPSDT Kentucky EPSDT Georgia PeachCare for Kids Nevada Nevada Check Up Iowa Care for Kids Kansas KanCare Washington EPSDT 4
5 Why is it important? Focus attention on early prevention and treatment. The program consists of two mutually supportive components: 1. Assuring the availability and accessibility of required health care resources 2. Helping Medicaid recipients and their parents or guardians effectively use these resources 5
6 EPSDT Benefits Screening services Comprehensive health and developmental history Comprehensive unclothed physical exam Developmental/behavioral assessment Nutrition assessment and education Appropriate immunizations Laboratory tests including blood lead screening Vision and hearing services Dental screening and education Anticipatory guidance Family risk factors and stressors Any necessary health care and referral for further diagnostics and treatment 6
![org/clinical_practice.html ] American Academy of Pediatric Dentistry (AAPD) [aapd.](/docs-images/87/96613956/images/7-4.jpg "org/media/policies_guidelines/g_cariesriskassessmentchart.")
7 Immunization and periodicity schedules We recommend following established guidelines: Centers for Disease Control and Prevention Advisory Committee on Immunization Practices immunization schedules [cdc.gov/vaccines/acip/index.html ] American Academy of Pediatrics (AAP) periodicity schedule [brightfutures.aap.org/clinical_practice.html ] American Academy of Pediatric Dentistry (AAPD) [aapd.org/media/policies_guidelines/g_cariesriskassessmentchart.pdf ] American Academy of Family Physicians [aafp.org ] 7
8 Treatment and follow-up care When a screening service indicates the need for further evaluation and diagnosis, a referral or treatment is required without delay Evaluation, diagnosis and/or treatment may be provided at the time of the screening visit if the health care professional is qualified to provide the services Follow up care can be provided by: Primary care providers (e.g., family physicians or pediatricians) Specialists (e.g., neurologists, ophthalmologists and audiologists) Other health professionals (e.g., dentists, advanced practice nurses, psychologists and nutritionists) Community agencies 8
9 How to report EPSDT services Providers must bill Amerigroup using correct coding guidelines to ensure accurate reporting for EPSDT services Submit information directly to the state s immunization registry (ISIS) promptly Enroll in your state s Vaccines for Children program. Amerigroup regularly exchanges data with state immunization registries and lead registries where applicable. 9
10 Amerigroup Outreach program Preventive health services reminder (annual birthday reminder) EPSDT overdue service reminder postcard Provider letters/overdue EPSDT service listing for members 10
11 Resources for providers Provider manual/handbook EPSDT provider toolkit Distributed to primary care providers and posted on our provider website Includes: Guide to services and billing Assessment summary Preventive care resources 11
12 Next steps Review your provider manual/handbook and EPSDT provider toolkit. Call Provider Services at or your local Provider Relations representative if you have questions. Complete and submit the Training Verification form
13 Thank you! Thank you for completing the Amerigroup provider training program for improving EPSDT screening for members. 13
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